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Phase 2a Questions > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Angina - Exercise/stress treadmill ECG results

A

ST segment depression - late stage ischaemia

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2
Q

Acute pericarditis - Pain

A
  1. Sharp and pleuritic
  2. Worse on lying flat and better with leaning forward
  3. Left ant chest or epigastrum
  4. Radiates to arm (trapezius ridge - share innervation with phrenic N)
  5. If acute - can be on inspiration
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3
Q

Mitral regurgitation - Ausculation

A
  1. Soft S1 (mitral and tricuspid valve closure)
  2. Pansystolic murmur - from apex to axilla - Intensity =/ severity
  3. Prominent 3rd extra heart sound (S3) in congestive HF/ LA overload
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4
Q

Hypertension - Pharmacological treatment

A

Goal = 140/90
ACD pathway
A - ACE inhibitor (Ramipril/Enalapril) / ARB (Candesartan/Losartan)
C - CCB (Nifedipine/Amlodipine) - 1st line if Black/over 55
D - Diuretics - Thiazide (Bendroflumethazide) or loop (Furosemide)

B blocker - B1 selective (Bisoprolol/Metoprolol) if young/intolerant

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5
Q

Action of Heparin

A

Thrombin and factor Xa inhibitor

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6
Q

Infective Endocarditis - clinical manifestation

A

FROMJANE
F - fever
R - Roth’s spots (retinal haemorrhages w white clear centres on fundoscopy)
O- Osler’s nodes (tender nodules in digits)
M - Murmur of heart
J - Janeway lesion (haemorrhages and nodules in fingers)
A - Anaemia
N - Nail splinter haemorrhage
E - Embolic skin lesions (black spots)

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7
Q

Blood pressure definition

A

Cardiac output x Total Peripheral Resistance

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8
Q

Heart failure - Blood Tests

A

Brain natriuretic peptide (BNP)

  • secreted by vesicles
  • Response to increased myocardial wall stress
  • Correlate w heart failure severity
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9
Q

ACE inhibitor- Bradykinin breakdown

A
  1. Dry chronic cough
  2. Rash
  3. Anaphylactoid reaction
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10
Q

Angina - Scoring

A
  1. Central, tight chest pain w radiation to arms / jaw / neck
  2. Precipitated by exertion
  3. Relieved by rest / GTN spray
    1/3 = non-anginal
    2/3 = atypical
    3/3 = typical
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11
Q

QRISK

A
  1. Age
  2. Gender (male)
  3. Angina/MI in 1st degree relative
  4. Smoking
  5. Hypertension
  6. Hyperlipidaemia
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12
Q

ACE inhibitor + SE

A

Ramipril

Dry chronic cough

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13
Q

MI - ECG

A 
Few mins
1. Hyperacute T waves
2. ST elevation
Few hours
1. T wave inversion
2. R wave voltage decrease
3. Pathological Q waves
Few days
1. ST normal
Few weeks/mth
1. T wave normal
2. Q wave remains
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14
Q

Heart failure - Symptoms

A

Cardinal S

  1. SOB
  2. Fatigue
  3. Ankle swelling
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15
Q

Heart failure - CXR

A 
ABCDE
A- Alveolar oedema
B - Kerley B lines
C - Cardiomegaly
D - Dilated upper lobe vessels of lungs
E - Effusions (pleural)
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16
Q

Tetralogy of Fallot - features

A
  1. Large, maligned ventral septal defect (VSD)
  2. Overriding aorta
  3. RV outflow obstruction (due to pulmonary stenosis)
  4. RV hypertrophy
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17
Q

Pericarditis - ECG

A
  1. Diagnostic
  2. Widespread concave upwards (saddle shaped) ST elevation
  3. Diffuse ST segment elevation in all leads (STEMI - limited to infarcted A)
  4. PR depression
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18
Q

Atrial Fibrillation - ECG

A
  1. No P waves

2. Irregular + rapid QRS complex

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19
Q

Aortic dissection - Clinical presentation

A
  1. Sudden onset of severe + central tearing chest pain - radiate to back and down arms (maximal at onset - unlike MI)
  2. Hypertension
  3. Acute lower limb ischaemia
  4. Neurological S - paraplegia (loss of blood supply to spinal cord)
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20
Q

Chronic limb ischaemia - stages

A
  1. Asymptomatic
  2. Intermittent claudication (cramp on exercise)
  3. Rest pain/nocturnal pain
  4. Necrosis/gangrene
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21
Q

Hypertension - secondary causes

A
  1. Renal disease
  2. Endocrine - Cushing’s, Conn’s
  3. Coarctation of aorta
  4. Drugs –> corticosteroids
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22
Q

Shock - Definition

A

Acute circulatory failure w inadequate/inappropriate distributed tissue perfusion
Hypoxia +/or inability of cells to utilise O2

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23
Q

Shock - Types

A
  1. Cardiogenic
  2. Septic
  3. Anaphylactic
  4. Hypovolaemic
  5. Neurogenic
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24
Q

Aneurysm - complications

A
  1. Rupture
  2. Thrombosis
  3. Embolism
  4. P on other structures
25
Q

Mitral Stenosis - Heart Sounds

A
  1. Diastolic murmur (blood flows over valve)
    - Low pitched diastolic rumble at apex
    - Lying on L side in held expiration
    - Severe = longer
  2. Loud opening S1 snap
    - At apex when leaflets still mobile - then softens and disappears
    - Abrupt halt in leaflet motion as leaflet tips fuse
    - Severe = closer to S2
26
Q

Aortic stenosis - Heart sounds

A
  1. Soft/absent S2
  2. Prominent S4 - LV hypertrophy
  3. Ejection systolic murmur - crescendo decrescendo
  4. Loudness =/ severity
27
Q

Action of CCB

A
  1. Block L type Ca channels
  2. Dihydroopyridines (felodipine / amlodipine)
    - Peripheral arterial vasodilators
  3. Verapamil
    - Negative chonotrope (HR) and negative inotrope (Force of contraction)
  4. Diltiazem (both)
28
Q

NSAID action

A
  1. Inhibit cyclooxygenase (COX) - breaks down arachidonic acid to prostaglandin H2 - less thromboxane A2
29
Q

Warfarin

A
  1. Inhibits vit K - prevent clotting
30
Q

Ventricular tachycardia - Treatment

A
  1. B blockers - bisoprolol /atenolol (B1)
  2. Sustained (>30s)
    IV amiodarone
    Emergency electrical cardioversion
31
Q

Furosemide action

A

Block Na/K/2Cl transporter

32
Q

ACE inhibitor action

A

Reduce circulating levels of aldosterone

Pril

33
Q

Digoxin effect

A
  1. Bradycardia
  2. Increased ectopic activity (extra hearbeats)
  3. Positive inotrope (increase force of contraction) by increased intracellular Ca
  4. Slow AV conduction
34
Q

Chronic Heart Failure - Pharmacology

A
  1. ACE inhibitor (ramipril) /ARB
  2. B blocker (bisoprolol)
  3. Diuretics
    - Loop (ferosemide)
    - Bendroflumethiazide
    - Aldosterone antagonist (spirolactone)
  4. Digoxin
  5. Inotropes
35
Q

B blocker SE

A
  1. Bronchospasm
  2. Heart failure
  3. Hypotension
  4. Bradyarrhythmias
36
Q

Nitrates - SE

A
  1. Headache
  2. GTN spray syncope
  3. Tolerance
37
Q

CCB - SE

A
  1. -ve chonotrope
    - Bradycardia
    - AV block
    - Postural hypotension
  2. Peripheral vasodilation
    - Flushing
    - Headache
    - Oedema
    - Palpitations
  3. -ve inotrope
    - Worse cardiac failure
  4. Verapamil = constipation
38
Q

Alpha 1 adrenoreceptor blocker

A

Doxazosin

39
Q

B blocker action

A
  1. Reduce O2 demand
    - Slow hr
    - Reduce force of contraction
  2. Improve O2 distribution
    - Slow hr
40
Q

Glyceryl trinitrate action

A
  1. Venodilation
  2. Reduce venous return to R heart
  3. Reduce preload
  4. Reduce work of heart
  5. Reduce O2 demand
41
Q

SAN

A

Dominant pacemaker
Intrinsic rate of 60-100bpm
Fastest depolarising tissue

42
Q

ECG paper

A
  1. Horizontal
    - 1 small box = 0.04s
    - 1 big box = 0.2s
  2. Vertical
    - 1 large = 0.5mV
43
Q

CO

A

CO (L/min) = SV (L) x HR (BPM)

44
Q

Heart sounds

A

S1 - Mitral/tricuspid valve closure
S2 - Aortic and pulmonary V closure
S3 - Early diastole during rapid ventricular filling
- children, preg, MR, HF
S4 - Gallop in late diastole - blood forced into stiff hypertrophic ventricle - LV hypertrophy

45
Q

Cardiac failure - Definition

A

Inability of heart to deliver blood + O2 at a rate that is commensurate w requirement of metabolising tissue of body

46
Q

Infective endocarditis - causative organisms

A
  1. Staph aureus
  2. Pseudomonas aeruginosa
  3. Strep viridans (dental problem)
47
Q

Acute pericarditis - Definition

A

Acute inflammation of pericardium - w/wout effusion

48
Q

Hypertension - values

A
  1. Normotensive <140/90
  2. Stage 1
    - >140/90
    - ABPM/HBPM >135/85
  3. Stage 2
    - >160/100
    - 150/95
  4. Severe
    - S>180 +/or D>110
    - Immediate Tx
49
Q

Cardiac arrhythmias - complications

A
  1. Sudden death
  2. Syncope
  3. HF
  4. Chest pain
  5. Dizziness
  6. Palpitations
  7. Asymptomatic
50
Q

RBBB - ECG

A
  1. MaRRoW
    - QRS like M in V1
    - QRS like W in V5+6
51
Q

LBBB - ECG

A
  1. WiLLiaM
    - QRS like W in V1-2
    - QRS like M in V4-6
52
Q

Aneurysm - Definition

A

Permanent dilation of A to twice normal diameter

53
Q

Acute Lower Limb ischaemia - symptoms

A 
6P's
1. Pain
2. Pallor
3. Perishing cold
4. Pulseless
5. Paralysis
6. Paraesthesia
More Ps = more severe
54
Q

Shock - recognise

A
  1. Cold, sweaty, pale, vasoconstricted skin
  2. Weak/rapid pulse
  3. Pulse P reduced
    - Mean arterial P maintained
  4. Reduced urine output
  5. Coma
55
Q

Haemorrhagic Shock Classification

A

Class I vs Class II vs III

  • 15% blood loss vs 15-30 vs 30-40
  • Pulse < 100bpm vs >100bpm vs >120
  • BP normal in I and II vs decreased
  • RR 14-20 vs 20-30 vs decreased
  • Urine output >30ml/hr vs 20-30 ml/hr vs 5-15
  • Slightly vs mildly anxious vs confused
56
Q

Peripheral Vascular disease - Classification

A 
Fontaine
I = asynical symptoms
IIa = mild claudication
IIb = mod-severe claudication
III = ischaemic rest pain
IV = ulceration / gangrene
57
Q

Cardiac Failure - Classifications

A 
New York Heart Association 
Class I : No limitation
Class II : Slight limitation
Class III : Marked limitation
Glass IV: Inability to carry out physical activity without discomfort
58
Q

CHADSVASC score

A

Chance of stroke in atrial fibrillation

59
Q

Hypertension - Diagnosis

A
  1. Serum creatinine
  2. eGFR
  3. Glucose
  4. ECG –> LV hypertrophy
  5. Fundoscopy - retinal haemorrhage / papilloedema

Phase 2a Questions (14 decks)

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